You’ve paid into your benefits plan for years. You’ve followed all the rules. But when you need it most, your ERISA claim is denied. This shock may hit you like a punch to the gut. You’re left wondering: Why is this happening to me?
ERISA, or the Employee Retirement Income Security Act, was meant to protect workers’ benefits. But the system isn’t perfect. Claim denials are more common than you might think. However, understanding why claims get denied is the first step in making sure your ERISA claim gets approved. Let’s look at the three most common reasons this happens.
Incomplete or incorrect paperwork
The paperwork maze can trip up even the most careful person. Insurance companies often reject claims due to missing or wrong information. This could be:
- Forgetting to sign a form
- Leaving out important medical details
- Providing outdated contact information
Even small mistakes can lead to big headaches. Double-check your paperwork to avoid this issue.
Lack of medical evidence
Sometimes, claims get denied because the insurance company doesn’t think you’ve provided enough proof. They may say:
- Your medical records don’t show your condition is severe enough
- You haven’t tried other treatments first
- Your doctor’s notes don’t match your claim
Getting thorough documentation from your health care providers can help prevent this issue.
Preexisting conditions
Insurance companies often use preexisting conditions as a reason to deny claims. They might argue that:
- Your current health problem is related to a condition you had before
- You didn’t disclose a health issue when you enrolled in the plan
- Your condition isn’t covered under the policy
This can be tricky to deal with, especially if you’re unsure about your policy’s fine print.
Remember, insurance companies have teams of experts working for them. They know the ins and outs of ERISA law. But you don’t have to face this challenge alone.
If your claim gets denied, don’t give up hope. Consider speaking to a lawyer who can guide you through the appeal process and get the benefits you deserve.
